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Reference Desk

Every Practice Needs a Manager

by Mark Opperman, CVPM
    Vets

    “When does a practice need a practice manager?” This is a question I am often asked, and my answer is that every practice needs a practice manager. The real question is, what type of manager do you need?

    What Types of Manager Are There?

    There are three categories of practice managers: office manager, practice manager, and hospital administrator.

    Office Manager

    An office manager is usually a head receptionist who has been given some additional management responsibilities, such as helping with accounts receivable or inventory control. This person has very limited management responsibilities and normally has little training in business or veterinary practice management.

    Practice Manager

    The practice manager is someone between the office manager and the hospital administrator. This individual spends at least half of his or her working time in management and has had some training in practice management; however, this position may not be a full-time job. The practice manager is normally in transition from an office manager to a hospital administrator.

    Hospital Administrator

    The hospital administrator is responsible for all areas of hospital management, including the oversight of associate veterinarians from a management perspective. Indeed, this is the major difference between a practice manager and a hospital administrator. The hospital administrator is responsible for ensuring that associate doctors are charging for their services, are not tardy, and get all their work done. However, unless the hospital administrator is also a veterinarian, he or she does not oversee the medical and surgical competency of associates. Instead, this responsibility falls to the owner or the board of directors of the hospital.

    How Do You Know What Type of Manager Your Practice Needs?

    Salary

    A key to determining what type of manager your practice needs is what you can afford. You should spend 3% to 4% of your gross revenue on management. This sum should cover all aspects of management within your practice. So if you have an office manager and a hospital administrator, or if the owner is spending time on management, everyone’s practice management activities should come out of this 3% to 4% of gross.

    Normally, office managers earn $1 or $2 more per hour than a lead receptionist. Practice managers are paid in the range of $40,000 to $50,000 per year, and hospital administrators make $80,000 or more a year plus benefits. Based on these numbers, if you calculate 3% to 4% of your gross revenue, you will have a good idea of what level of manager you’re looking for.

    Duties

    Once you have figured out what kind of manager you can afford, the next step is to determine what this individual will do in your hospital. I suggest that you develop a job description for your manager. Commercially available job descriptions for office managers, practice managers, and hospital administrators exist, or you can create your own. Good examples of these job descriptions are available here:

    Training

    As mentioned above, an office manager is basically a lead receptionist who is taking on some additional management responsibilities. This position does not require a great deal of management training. However, a practice manager needs to be trained and experienced in management. Over the years, I have hired many managers for a variety of veterinary practices. Most people want to hire someone with veterinary experience, and this may indeed be a plus, but it is not necessarily a requirement of the position. I have hired many practice managers who had been managers of medical offices or small businesses. Management is management, and about 60% of the manager’s job will be personnel management. Hiring someone who has excellent training in human resources and who has successfully managed a small or medium-sized office can work out very well.

    If, on the other hand, you are looking to develop a practice manager from your existing staff, the person you are considering may not have had any previous management training. This lack of experience should not rule him or her out for the position; however, for the benefit of everyone involved, you should seriously consider enrolling this individual in some basic management courses. Being a nice person or a long-time employee does not equal innate management ability. Fortunately, management training is available from many sources. Check your local community college or university course listings to see what they offer, or Google “management training” to see the many programs that exist. My company, VMC, also offers management training specific to veterinary practices (see BOX 1).

    Box 1. VMC School of Veterinary Practice Management

    About 20 years ago, there really weren’t any true veterinary practice management training programs. Having been an administrator myself for more than 10 years at that time, I knew what was required to be an effective manager, so I designed a school around these skills. The VMC School of Veterinary Practice Management is an intensive, comprehensive 1-week training program designed to teach practical practice management. We also provide 6 months of follow-up for new graduates. For more information about the school, click here.

    When hiring a hospital administrator, I look for someone with veterinary experience and a great deal of competency. Hopefully, you have heard of the certified veterinary practice manager (CVPM) designation. The CVPM certification is a process that I and several other people developed some 15 years ago. It is administered under the auspices of the Veterinary Hospital Managers Association. Originally, it was designed to be similar to the certification process for certified public accountants. CVPM applicants had to complete a very detailed application process; then, if they were qualified, they sat for both oral and written examinations. The certification process has now become standardized, and, in the process, the oral exam has been eliminated, but applicants must still undergo an extensive application process and written exam. To successfully pass the exam, candidates must have competency in many different areas of practice management. CVPMs must complete yearly continuing education requirements and are held to a very high standard. There are currently about 250 CVPMs in the United States. If you hire a CVPM, you can be assured that you are hiring a very competent veterinary manager. For more information about CVPMs, go to VHMA.org.

    You’ve Got to Let Go!

    Now, let’s say you’ve identified the type of manager you need, developed a job description, hired someone, and made sure they have the adequate training to do the job. The next step is that you, the practice owner, must let go and allow them to do the work! You have no idea how hard this is for many veterinarians. When I consult with veterinary practices, I often find that the process of interviewing, hiring, and even training any manager is almost easy compared with getting the practice owner to step back and allow the manager to do his or her job. This is particularly true in smaller practices (gross revenue <$1.5 million), where the owner may be used to handling all the management on a daily basis.

    The key to a successful transition is defining the manager’s roles and responsibilities and setting up internal controls on what he or she can do. You may have heard horror stories about practice owners who hired a practice manager and turned that person loose in their hospital only to find that the manager embezzled from them or created havoc among the team members. But there are also many success stories in which hiring a manager results in the practice being managed better, allowing the owner to take some time off, develop other areas of the practice, or enhance his or her quality of life.

    Internal controls make the difference. Delegation is not abdication. For example, if you give your manager the duties of paying bills and taking care of accounts receivable, you cannot just turn these responsibilities over and walk away. As the owner of the practice, you should always sign the checks so that you know what payments are being made. You should review bank statements at the end of the month and the financial reports from your veterinary software program and your accounts payable system. Only you, the owner, should be able to write off accounts. You should also monitor your aged accounts receivable on a monthly basis. It is still your practice, and you must know what is going on in it. There are many checks and balances you can put into place to make sure the practice is running well and that your manager is effective.


    For more about the importance of checks and balances, read Case Report: How Did We Hire This Person?



    ***

    Hiring and/or developing a manager within your practice may be one of the best things you ever do, if it is done correctly. Most veterinarians were not trained to be managers, and, frankly, I think most would prefer not to have to deal with the management of their practice. I can’t count the number of times I have heard, “I went to school to be a veterinarian, not a manager.”

    So, do you wish to improve the quality of practice management in your practice? Do you wish to spend more time doing medicine or surgery? Do you want to spend less time at the practice and more time with family and friends? Then maybe you should consider hiring a manager for your practice.

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